ICD-10 SPECIALTY TIPS

PREGNANCY, CHILDBIRTH AND THE PUERPERIUM DELVERIES | 1 of 4

SPECIALTY TIP #1 Pregnancy, Childbirth and the Puerperium Deliveries In coding, the codes tell a story. The more detailed the story, the better to assess the situation and condition of the patient at the point of the encounter between the physician and the patient. Every condition involving pregnancy should have documentation of the weeks of gestation as many of the codes depend on that documentation to determine the risk to the mother and/or child in order to assign the value of the procedures (i.e., premature fetus vs. full term).

Encounter Scenario ICD-10 What is needed? Normal Spontaneous Vaginal Birth, single birth

O80 – Encounter for full-term uncomplicated delivery Z3A.38 – 38 weeks gestation/ 3rd trimester Z37.0 – Single live birth

• Note the specific wording of “full-term” and “uncomplicated” – this means without fetal manipulation or instrumentation

• Code cannot be used if there are any noted complications

• You will need to indicate the number of weeks gestation

• You will always need to indicate the outcome of delivery (“single live born”, “twin-one live born, one stillborn”, etc.)

Cesarean delivery without indication, twins

O82 – Encounter for cesarean delivery without indication Z3A.35 – 35 weeks gestation/ 3rd trimester Z37.2 – Twins, both liveborn

• You will need to indicate the number of weeks gestation

• You will always need to indicate the outcome of delivery

• Usually there is a reason for a C/section (fetal distress, prolapse of cord, etc.) unless it is planned (different code) – coding would then center on “labor & delivery complicated by....”

Premature delivery, 32 weeks, breech, single liveborn

O60.14X0 – Term delivery with preterm labor, 3rd trimester, single gestation O32.1XX0 – Maternal care for breech presentation, single gestation Z37.0 – Single live birth Z3A.32 – 32 weeks gestation

• Be sure to indicate any complications, this will change the codes chosen to reflect the difficulty with the birth (and the care you have to extend)

• You will need to indicate the number of weeks gestation

• You will always need to indicate the outcome of delivery

Repeat cesarean section, full term-36 weeks, 4 days, single liveborn

O34.21 – Maternal care for scar from previous cesarean delivery Z37.0 – Single live birth Z3A.36 – 36 weeks completed gestation

• Be sure to indicate any complications, this will change the codes chosen to reflect the difficulty with the birth (and the care you have to extend)

• You will need to indicate the number of weeks gestation

• You will always need to indicate the outcome of delivery

The old classifications of “delivered”, “antepartum”, and “postpartum” have been replaced with the trimester of pregnancy based on the current admission/encounter in many of the codes.

• 1st trimester: Less than 14 weeks 0 days • 2nd trimester: 14 weeks 0 days to less than 28 weeks 0 days • 3rd trimester: 28 weeks 0 days until delivery

There is an additional direction within the ICD-10 book that directs: “Use additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy” (By noting the number of weeks/days gestation, the coder should be able to determine the trimester division available to them.)

ICD-10 SPECIALTY TIPS

PREGNANCY, CHILDBIRTH AND THE PUERPERIUM DELVERIES | 2 of 4

Outcome of Delivery

Outcome of delivery is required for all deliveries (single liveborn, single stillborn, twins-both liveborn, etc.). Simply adding the end time is insufficient to fulfill this requirement. Outcome of delivery is a separate, secondary code that is added to the primary diagnostic code. Also, the number of weeks gestation should be documented. The sex of the baby is not required. We have accepted APGAR scores as they show the status of the baby, however, we do prefer the straightforward “Single, live birth”.

Rationale: Delivery of liveborn infant sets up the expectation of charges submitted for the new baby. Should there be a twin or multiple births, the potential for problems increases. Should the mother not deliver, then the future charges for the actual delivery would not be denied as duplicate billing.

The number of weeks gestation included on any charges for a pregnant patient is an indicator of potential problems for both the mother and child especially if not full term. • Example: Patient receives labor epidural then delivers single liveborn infant without complications at 38 weeks – O80 – Encounter for full-term uncomplicated delivery Z3A.38 – 38 weeks gestation/ 3rd trimester Z37.0 – Single live birth • Problem Scenario: Patient sent home undelivered after receiving epidural. •Problem Scenario: Patient received labor epidural then progressed to C/section. Without sufficient information the labor to c/section may not be caught for appropriate coding.

Complications of deliveries should be noted in detail.

• It will help to explain if you note Physical Status above a level I or II. • Your documentation will support a potentially longer procedure than would normally be anticipated. • Outside of a normal, spontaneous vaginal delivery the codes can potentially get more detailed to explain the

increased difficulties you are encountering during the delivery.

See the direction from ICD-10

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A) a. General Rules for Obstetric Cases

5) Outcome of delivery A code from category Z37, Outcome of delivery, should be included on every maternal record when a delivery has occurred.

ICD-10 SPECIALTY TIPS

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Condition ICD-10 Additional Information Ectopic pregnancy O00.9 Weeks of gestation? Abdominal, with viable fetus? Tubal? Ovarian? Complicated by

(infection, renal failure, sepsis, hemorrhage, etc.)? Failed induction of labor O61.9 Trimester? Fetal Distress O77.9 Episode surrounding baby or mother? If mother, complicating pregnancy or labor and

delivery? Meconium in amniotic fluid? Due to drug administration? Incompetent cervix O34.31 ICD-10 code specific to trimester, requires week of gestation Missed Abortion O02.1 Specify number of weeks gestation. Specify any complications. This code for early fetal

death before completion of 20 weeks of gestation with retention of dead fetus Prolapsed cord O69.01 Trimester?

Changes in 2018 ICD-10

There are several changes in the coding guidelines for 2018:

15. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A) q. Termination of Pregnancy and Spontaneous abortions 2) Retained Products of Conception following an abortion Subsequent encounters for retained products of conception following a spontaneous abortion or elective termination of pregnancy, without complications are assigned O03.4, Incomplete spontaneous, abortion without complication, or codes O07.4, Failed attempted termination of pregnancy without complication. This advice is appropriate even when the patient was discharged previously with a discharge diagnosis of complete abortion. If the patient has a specific complication associated with the spontaneous abortion or elective termination of pregnancy in addition to retained products of conception, assign the appropriate complication in category O03 or O07 instead of code O03.4 or O07.4

3) Complications leading to abortion Codes from Chapter 15 may be used as additional codes to identify any documented complications of the pregnancy in conjunction with codes in categories in O04, O07 and O08.

NewCodesfor2018CODE DESCRIPTIONS WITHOUT INTRAUTERINE

PREGNANCY WITH INTRAUTERINE

PREGNANCY Right tubal pregnancy O00.101 O00.111 Left tubal pregnancy O00.102 O00.112 Unspecified tubal pregnancy O00.109 O00.119 Right ovarian pregnancy O00.201 O00.211 Left ovarian pregnancy O00.202 O00.212 Unspecified ovarian pregnancy O00.209 O00.219

CODE DESCRIPTIONS UNSPECIFIED FIRST SECOND THIRD Maternal care for abnormalities of the fetal heart rate or rhythm, not applicable or unspecified

O36.8390 O36.8310 O36.8320 O36.8330

Maternal care for abnormalities of the fetal heart rate or rhythm, fetus 1

O36.8391 O36.8311 O36.8321 O36.8331

Maternal care for abnormalities of the fetal heart rate or rhythm, fetus 2

O36.8392 O36.8312 O36.8322 O36.8332

Maternal care for abnormalities of the fetal heart rate or rhythm, fetus 3

O36.8393 O368313 O36.8323 O36.8333

Maternal care for abnormalities of the fetal heart rate or rhythm, fetus 4

O36.8394 O36.8314 O36.8324 O36.8334

Maternal care for abnormalities of the fetal heart rate or rhythm, fetus 5

O36.8395 O36.8315 O36.8325 O36.8335

ICD-10 SPECIALTY TIPS

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Maternal care for abnormalities of the fetal heart rate or rhythm, other fetus

O36.8399 O36.8319 O36.8329 O36.8339

DeletedCodesICD-10 CODE CODE DESCRIPTIONS

O00.10 Tubal pregnancy without intrauterine pregnancy O00.11 Tubal pregnancy with intrauterine pregnancy O00.20 Ovarian pregnancy without intrauterine pregnancy O00.21 Ovarian pregnancy with intrauterine pregnancy

RevisedCodeICD-10 CODE

CODE DESCRIPTIONS CHANGE DETAIL O00.212 Left ovarian pregnancy with intrauterine pregnancy The word “without” has been changed to “with” in

the code description ICD-10 presents the opportunity to explain in detail the circumstances surrounding the encounter and it supports the medical necessity for your inclusion in the care for the patient.

The information provided is only intended to be a general summary and not intended to take place of either written law or regulations. © Abeo Management Corporation, 2017.